End of year update on euthanasia, assisted suicide and palliative care

By Dr. Peter Saunders

Editor’s note. Dr. Saunders is a former general surgeon and is CEO of Christian Medical Fellowship, a UK-based organization with 4,500 UK doctors and 1,000 medical students as members.

Dr. Peter Saunders

As 2012 draws to a close, we look back over a busy twelve months, and ahead to the challenges that 2013 holds in store.

Lord Falconer’s ‘Commission on Assisted Dying’

The Falconer Commission reported on January 5, predictably recommending a change in the law to permit assisted suicide (not euthanasia) for mentally competent adults with less than twelve months to live. The general media coverage was very balanced, and the divisions within the pro-euthanasia movement became clear, with some arguing that the Commission had not gone nearly far enough. CARE NOT KILLING [Care Not Killing] played a prominent role in discrediting the Commission, with 40 media interviews in 24 hours.

Whitehall & Westminster

The Government promised £1.5m for research exploring suicide prevention among those most at risk of taking their own lives, as part of a new suicide prevention strategy aimed at cutting the suicide rate and providing more support to bereaved families.

This summer’s Government reshuffle produced two new junior health ministers, Anna Soubry and Norman Lamb, who have since spoken out in favour of relaxing the law on assisted suicide. But a poll commissioned by CARE NOT KILLING (covered by outlets including ConservativeHome, the Telegraph and Press Association) has shown that just 29% of MPs back moves to introduce assisted suicide (59% were opposed) and indeed, it has been a positive year for our cause in Westminster.

David Burrowes MP led a Westminster Hall debate in January at which MPs in attendance signalled a desire for the debate about end of life issues to be based upon providing excellent palliative care rather than any measure to introduce assisted suicide.

Director of Public Prosecutions’ guidelines

March 27th saw one of the year’s most impassioned debates on the floor of the House of Commons, as Members debated whether or not to put the Director of Public Prosecutions’ (DPP) guidelines regarding assisted suicide on a statutory footing. This had been a goal of DiD and their Parliamentary allies, with the aims of obtaining assurances of no prosecution ahead of time for specific cases of assisted suicide, and creating an exemption for healthcare workers. The Government told the Lords in February that the DPP should remain ‘unfettered’, and MPs concluded that improved palliative care should be the priority, Richard Ottaway MP having withdrawn his original motion. Debate was respectful, but Members were clear: care, not killing.

BMA

The British Medical Association’s annual representative meeting in June saw 14 of 20 motions regarding euthanasia or assisted suicide seek to relax the BMA’s policy on the subject. One of these, Motion 332, seeking to move the British Medical Association (BMA) to a neutral position on ‘Assisted Dying’, was debated and defeated by a large majority despite having substantial support from the British Medical Journal. The BMA vote was the most serious threat since 2005, and the vote clearly demonstrates that the medical profession remains overwhelmingly ‘on side’.

Nicklinson & Martin

On 19-22 June, three High Court Judges heard the joined cases of two men with conditions resembling locked-in syndrome, seeking to challenge the 1965 Murder Act. Tony Nicklinson argued that the principle of necessity should allow a doctor to end Nicklinson’s life without fear of prosecution for murder, and that the current laws interfere with his Article 8 right to his private life. ‘AM’ (referred to as ‘Martin’ in court) additionally wants the DPP, the Solicitor’s Regulatory Authority and the General Medical Council to make clear in advance the extent to which solicitors and doctors could assist his suicide. CARE NOT KILLING was granted permission to intervene in both cases, and Justices Toulson, Royce & Macur rejected both applications in August, saying that it was a ‘matter for Parliament.’

Nicklinson’s death six days later attracted extensive media interest and coverage. His wife unsuccessfully sought to intervene on his behalf, but she is now appealing that decision, while ‘Martin’ has been granted leave to take his case to the Court of Appeal.

First European Symposium on Euthanasia and Assisted Suicide

The first European Congress on Euthanasia Prevention in Edinburgh (September 6-8 ) was a great success, with around 100 delegates and attendees from a dozen countries being addressed by “passionate and committed speakers”. Those assembled discussed ongoing threats across Western Europe and North America, with experiences shared and relationships developed, and contributions from disability rights campaigners were singled out for particular praise.

Liverpool Care Pathway

Controversy has built over the latter half of this year regarding the Liverpool Care Pathway (LCP), a framework for the care of those in the final hours or days of life. The press has helped to bring to light numerous cases of its misapplication, and the ensuing level of concern has drawn both condemnation and support from the highest levels of the Government, the medical & care sector and patients’ groups.

On November 26, Care Minister Norman Lamb MP convened roundtable talks with parliamentarians, doctors and patients’ representatives to discuss the LCP. During the meeting, at which Care Not Killing was represented, the Minister announced a far-reaching review to consider the various issues raised, with an independent chair. The review will consider the findings of three existing reviews being conducted by the Association of Palliative Medicine (‘on the implementation of the pathway and the experience of professionals’), Dying Matters (‘on the experience of the patient and their loved ones’) and the End of Life Care Strategy (‘on complaints surrounding the LCP and end of life care in hospitals’). The announcement received widespread media attention (BBC, Telegraph, Guardian, Mail).

Care Not Killing has been an active part of this debate throughout, and our basic position has been that the LCP is a useful clinical tool when used correctly–with many thousands of people benefiting from it–but that there is clearly a need for change, and we have already published a number of recommendations.

Massachusetts

The US state of Massachusetts voted 51%-49% in a referendum on November 6 to reject the legalisation of physician-assisted suicide for the terminally ill. The measure was defeated after a strong campaign by a diverse coalition called ‘No on Question 2′, comprised of disability rights organisations, doctors, nurses, community leaders, faith based groups and patients’ rights advocates.

NEXT YEAR: Holyrood [Scottish Parliament] legislation

Two years since her last attempt was defeated in Edinburgh by a massive 85-16, Margo MacDonald MSP is gearing up to introduce her new Assisted Suicide (Scotland) Bill in the spring, and has promised a ‘tougher fight’. Her proposals are based loosely on the Oregon model. Despite the fact that 65% of responses to her own consultation were opposed to any change in the law, she intends to press ahead, supported by DiD and with the backing of the required 18 MSPs.

NEXT YEAR: Westminster legislation

Although two APPGCEL MPs came 2nd and 4th in the private members’ ballot, neither opted to bring forward relevant legislation, so a new attempt to introduce legislation to Westminster will most likely be by Lord Falconer in the upper chamber. DiD and the ‘Choice at the End of Life’ All-Party Group (APPGCEL) published a new bill ‘for consultation’ along the lines of the Falconer Commission recommendations (i.e. assisted suicide for mentally competent adults with less than twelve months to live, with essentially the same ‘Joffe’ safeguards). The ‘consultation’ closed on 20 November and we await its report and the timescale for the bill.

NEXT YEAR: Courts

Here in Britain, Jane Nicklinson and ‘Martin’ are set to appeal the judgement handed down at the High Court in August. Our counterparts abroad face similarly significant legal challenges, and as we were conscious of ahead of the Massachusetts vote, foreign precedents impact here.

Ireland’s High Court will rule on January 10 in the landmark case of Marie Fleming, a terminally ill MS patient (and partner of Exit International’s European leader, Tom Curran) seeking the right to be assisted in taking her own life. In Canada, the Euthanasia Prevention Coalition has been granted permission to intervene in the appeal of a British Columbia assisted suicide ruling (set for March), while the Canadian Supreme Court continues to hear evidence in the Rasouli case, in which a family is battling doctors to maintain life support for their husband and father.

NEXT YEAR: RCGP

Royal College of General Practitioners Council Chair Clare Gerada’s November newsletter devoted four paragraphs to the issue of assisted suicide, while in the December edition of the British Journal of General Practice (£), she argued that: ‘all Royal Colleges and Medical, Nursing, and other, umbrella medical organisations should… take a neutral stance on the issue of assisted dying…’

Following the fall of similar motions at the BMA this year, General Practice is set to be the new frontline for attempts to neutralise medical opinion.